March 08, 2018
Area(s) of Interest: Payor Issues and Reimbursement
Despite existing California law that prohibits unfair health plan payment practices, many of them continue to flout the law.
The Department of Managed Health Care (DMHC) has been slow to address provider complaints and has taken few enforcement actions against health plans that unlawfully underpay providers. When DMHC has acted, the penalty amounts have been small in relation to the economic injury to consumers and providers.
Because of this, some health care service plans make economic decisions to violate the law, knowing that any penalty amount that may be imposed will be outweighed by the extra revenue the health plans will generate by, for example, underpaying medical care.
The California Medical Association (CMA) is sponsoring AB 2674 (Aguiar-Curry) to increase penalties on DMHC regulated health plans that engage in unfair payment patterns. The bill would require DMHC to investigate provider complaints that a health plan has underpaid or failed to pay the provider as required by state law (under the Knox-Keene Act of 2000). If DMHC finds that a health plan has unlawfully underpaid a provider, AB 2674 would require a penalty amount at least equal the amount of the underpayment plus interest.
To support these efforts, CMA is looking for feedback from physician practices on health plans that are routinely engaging in unfair payment patterns, the types of violations and physician efforts to resolve the issues. We want to hear your story. Please share your experience by responding to our brief five minute survey.
The results of this survey will be crucial in helping us pass legislation to require increased penalties on plans that engage in these unfair payment patterns.
It is critical that we receive your response no later than March 16, 2018.